ENROLLED
Senate Bill No. 473
(By Senator Walker)
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[Passed March 9, 1996; in effect ninety days from passage.]
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AN ACT to amend and reenact sections two, three, seven and
twenty-two, article sixteen, chapter five of the code of
West Virginia, one thousand nine hundred thirty-one, as
amended, all relating to the administration of the West
Virginia public employees insurance agency; definitions;
salary of director; chief financial officer; providing that
for plans which include maternity benefits that these plans
not deny payment for specified minimum time periods where
deemed medically necessary by the attending physician;
optional life and accidental death insurance; and employer
contributions.
Be it enacted by the Legislature of West Virginia:
That sections two, three, seven and twenty-two, article
sixteen, chapter five of the code of West Virginia, one thousand
nine hundred thirty-one, as amended, be amended and reenacted,
all to read as follows:
ARTICLE 16. WEST VIRGINIA PUBLIC EMPLOYEES INSURANCE ACT.
§5-16-2. Definitions.
The following words and phrases as used in this article,
unless a different meaning is clearly indicated by the context,
have the following meanings:
(1) "Advisory board" means the public employees insurance
agency advisory board created by this article.
(2) "Agency" means the public employees insurance agency
created by this article.
(3) "Director" means the director of the public employees
insurance agency, created by this article.
(4) "Employee" means any person, including elected officers,
who works regularly full time in the service of the state of West
Virginia and, for the purpose of this article only, the term
"employee" also means any person, including elected officers, who
works regularly full time in the service of a county board of
education; a county, city or town in the state; any separate corporation or instrumentality established by one or more
counties, cities or towns, as permitted by law; any corporation
or instrumentality supported in most part by counties, cities or
towns; any public corporation charged by law with the performance
of a governmental function and whose jurisdiction is coextensive
with one or more counties, cities or towns; any comprehensive
community mental health center or comprehensive mental
retardation facility established, operated or licensed by the
secretary of health and human resources pursuant to section one,
article two-a, chapter twenty-seven of this code, and which is
supported in part by state, county or municipal funds; any person
who works regularly full time in the service of the university of
West Virginia board of trustees or the board of directors of the
state college system; and any person who works regularly full
time in the service of a combined city-county health department
created pursuant to article two, chapter sixteen of this code.
On and after the first day of January, one thousand nine hundred
ninety-four, and upon election by a county board of education to
allow elected board members to participate in the public
employees insurance program pursuant to this article, any person
elected to a county board of education shall be deemed to be an "employee" during the term of office of the elected member:
Provided, That the elected member shall pay the entire cost of
the premium if he or she elects to be covered under this act.
Any matters of doubt as to who is an employee within the meaning
of this article shall be decided by the director.
(5) "Employer" means the state of West Virginia, its boards,
agencies, commissions, departments, institutions or spending
units; a county board of education; a county, city or town in the
state; any separate corporation or instrumentality established by
one or more counties, cities or towns, as permitted by law; any
corporation or instrumentality supported in most part by
counties, cities or towns; any public corporation charged by law
with the performance of a governmental function and whose
jurisdiction is coextensive with one or more counties, cities or
towns; any comprehensive community mental health center or
comprehensive mental retardation facility established, operated
or licensed by the secretary of health and human resources
pursuant to section one, article two-a, chapter twenty-seven of
this code, and which is supported in part by state, county or
municipal funds; and a combined city-county health department
created pursuant to article two, chapter sixteen of this code. Any matters of doubt as to who is an "employer" within the
meaning of this article shall be decided by the director. The
term "employer" does not include within its meaning the national
guard.
(6) "Finance board" means the public employees insurance
agency finance board created by this article.
(7) "Plan" means the medical indemnity plan or a managed
care plan option offered by the agency.
(8) "Retired employee" means an employee of the state who
retired after the twenty-ninth day of April, one thousand nine
hundred seventy-one, and an employee of the university of West
Virginia board of trustees or the board of directors of the state
college system or a county board of education who retires on or
after the twenty-first day of April, one thousand nine hundred
seventy-two, and all additional eligible employees who retire on
or after the effective date of this article and meet the minimum
eligibility requirements for their respective state retirement
system: Provided, That for the purposes of this article, the
employees who are not covered by a state retirement system shall,
in the case of education employees, meet the minimum eligibility
requirements of the state teachers retirement system, and in all other cases, meet the minimum eligibility requirements of the
public employees retirement system.
§5-16-3. Public employees insurance agency continued;
appointment, qualification, compensation and duties of
director of agency; employees; civil service coverage;
director vested after specified date with powers of public
employees insurance board; expiration of agency.
(a) The public employees insurance agency is continued, and
consists of the director, the finance board, the advisory board
and any employees who may be authorized by law. The director
shall be appointed by the governor, with the advice and consent
of the Senate. He or she shall serve at the will and pleasure of
the governor, unless earlier removed from office for cause as
provided by law. The director shall have at least three years
experience in health insurance administration prior to
appointment as director. The director shall receive an annual
salary established by the governor not to exceed sixty-five
thousand dollars and actual expenses incurred in the performance
of official business. The director shall employ such
administrative, technical and clerical employees as are required
for the proper administration of the insurance programs provided
for in this article. The director shall perform such duties as are required of him or her under the provisions of this article
and is the chief administrative officer of the public employees
insurance agency.
(b) All positions in the agency, except for the director,
his or her personal secretary and the chief financial officer
shall be included in the classified service of the civil service
system pursuant to article six, chapter twenty-nine of this code.
Any person required to be included in the classified service by
the provisions of this subsection who was employed in any of the
positions included in this subsection on or after the effective
date of this article shall not be required to take and pass
qualifying or competitive examinations upon or as a condition to
being added to the classified service: Provided, That no person
required to be included in the classified service by the
provisions of this subsection who was employed in any of the
positions included in this subsection as of the effective date of
this section shall be thereafter severed, removed or terminated
in his or her employment prior to his or her entry into the
classified service except for cause as if the person had been in
the classified service when severed, removed or terminated.
(c) The director is responsible for the administration and management of the public employees insurance agency as provided
for in this article and in connection with his or her
responsibility shall have the power and authority to make all
rules necessary to effectuate the provisions of this article.
Nothing in section four or five of this article shall limit the
director's ability to manage on a day-to-day basis the group
insurance plans required or authorized by this article,
including, but not limited to, administrative contracting,
studies, analyses and audits, eligibility determinations,
utilization management provisions and incentives, provider
negotiations, provider contracting and payment, designation of
covered and noncovered services, offering of additional coverage
options or cost containment incentives, pursuit of coordination
of benefits and subrogation, or any other actions which would
serve to implement the plan or plans designed by the finance
board.
(d) The public employees insurance agency shall terminate in
the manner provided in article ten, chapter four of this code, on
the first day of July, two thousand one, unless extended by
legislation enacted before the termination date: Provided, That
the public employees insurance agency advisory board, created in section six of this article, shall terminate in the manner
provided in article ten, chapter four of this code on the first
day of July, one thousand nine hundred ninety-six.
§5-16-7. Authorization to establish group hospital and surgical
insurance plan, group major medical insurance plan, group
prescription drug plan and group life and accidental death
insurance plan; rules for administration of plans; mandated
benefits; what plans may provide; optional plans; separate
rating for claims experience purposes.
(a) The agency shall establish a group hospital and surgical
insurance plan or plans, a group prescription drug insurance plan
or plans, a group major medical insurance plan or plans and a
group life and accidental death insurance plan or plans for those
employees herein made eligible, and to establish and promulgate
rules for the administration of such plans, subject to the
limitations contained in this article. Those plans shall
include:
(1) Coverages and benefits for X-ray and laboratory services
in connection with mammograms and pap smears when performed for
cancer screening or diagnostic services; (2) Annual checkups for
prostate cancer in men age fifty and over;
(3) For plans that include maternity benefits, coverage for inpatient care in a duly licensed health care facility for a
mother and her newly born infant for the length of time which the
attending physician deems medically necessary for the mother or
her newly born child: Provided, That no such plan may deny
payment for a mother or her new born child prior to forty-eight
hours following a vaginal delivery, or prior to ninety-six hours
following a caesarean section delivery, if the attending
physician deems discharge medically inappropriate; and
(4) For plans which provide coverages for post-delivery care
to a mother and her newly born child in the home, coverage for
inpatient care following childbirth as provided in subdivision
(3) of this subsection if such inpatient care is determined to be
medically necessary by the attending physician. Those plans may
also include, among other things, medicines, medical equipment,
prosthetic appliances, and such other inpatient and outpatient
services and expenses deemed appropriate and desirable by the
agency.
(b) The agency shall make available to each eligible
employee, at full cost to the employee, the opportunity to
purchase optional group life and accidental death insurance as
established under the rules of the agency. In addition, each employee is entitled to have his or her spouse and dependents, as
defined by the rules of the agency, included in the optional
coverage, at full cost to the employee, for each eligible
dependent; and with full authorization to the agency to make the
optional coverage available and provide an opportunity of
purchase to each employee.
(c) The finance board may cause to be separately rated for
claims experience purposes: (1) All employees of the state of
West Virginia; (2) all teaching and professional employees of the
university of West Virginia board of trustees or the board of
directors of the state college system and county boards of
education; (3) all nonteaching employees of the university of
West Virginia board of trustees or the board of directors of the
state college system and county boards of education; or (4) any
other categorization which would ensure the stability of the
overall program.
§5-16-22. Permissive participation; exemptions.
The provisions of this article are not mandatory upon any
employee or employer who is not an employee of or is not the
state of West Virginia, its boards, agencies, commissions,
departments, institutions or spending units or a county board of education, and nothing contained in this article shall be
construed so as to compel any employee or employer to enroll in
or subscribe to any insurance plan authorized by the provisions
of this article.
Those employees enrolled in the insurance program authorized
under the provisions of article two-b, chapter twenty-one-a of
this code shall not be required to enroll in or subscribe to an
insurance plan or plans authorized by the provisions of this
article, and the employees of any department which has an
existing insurance program for its employees to which the
government of the United States contributes any part or all of
the premium or cost of the premium may be exempted from the
provisions of this article. Any employee or employer exempted
under the provisions of this paragraph may enroll in any
insurance program authorized by the provisions of this article at
any time, to the same extent as any other qualified employee or
employer, but employee or employer shall not remain enrolled in
both programs. The provisions of articles fourteen, fifteen and
sixteen, chapter thirty-three of this code, relating to group
life insurance, accident and sickness insurance, and group
accident and sickness insurance, are not applicable to the provisions of this article whenever the provisions of articles
fourteen, fifteen and sixteen, chapter thirty-three of this code
are in conflict with or contrary to any provision set forth in
this article or to any plan or plans established by the public
employees insurance agency.
Employers, other than the state of West Virginia, its
boards, agencies, commissions, departments, institutions,
spending units or a county board of education are exempt from
participating in the insurance program provided for by the
provisions of this article unless participation by the employer
has been approved by a majority vote of the employer's governing
body. It is the duty of the clerk or secretary of the governing
body of an employer who by majority vote becomes a participant in
the insurance program to notify the director not later than ten
days after the vote.
Any employer, whether the employer participates in the
public employees insurance agency insurance program as a group or
not, which has retired employees, their dependents or surviving
dependents of deceased retired employees who participate in the
public employees insurance agency insurance program as authorized
by this article, shall pay to the agency the same contribution toward the cost of coverage for its retired employees, their
dependents or surviving dependents of deceased retired employees
as the state of West Virginia, its boards, agencies, commissions,
departments, institutions, spending units or a county board of
education pay for their retired employees, their dependents and
surviving dependents of deceased retired employees, as determined
by the finance board: Provided, That after the thirtieth day of
June, one thousand nine hundred ninety-six, an employer is only
required to pay a contribution toward the cost of coverage for
its retired employees, their dependents or the surviving
dependents of deceased retired employees who elect coverage when
the retired employee participated in the plan as an active
employee of the employer for at least five years. Each employer
is hereby authorized and required to budget for and make such
payments as are required by this section.